Clin Endosc.  2014 Mar;47(2):178-182. 10.5946/ce.2014.47.2.178.

Endoscopic Treatment of Various Gastrointestinal Tract Defects with an Over-the-Scope Clip: Case Series from a Tertiary Referral Hospital

Affiliations
  • 1Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea. cjy6695@dreamwiz.com

Abstract

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.

Keyword

Over-the-scope clip; Natural orifice endoscopic surgery; Fistula; Subepithelial tumor; Anastomosis

MeSH Terms

Anastomotic Leak
Fistula
Gastrointestinal Tract*
Intestinal Perforation
Natural Orifice Endoscopic Surgery
Tertiary Care Centers*

Figure

  • Fig. 1 (A) Colonoscopic findings of dye leakage from a colon fistula on the transverse colon. (B) No dye leakage occurred after over-the-scope clip closure.

  • Fig. 2 (A) Endoscopic findings of early gastric cancer with submucosal invasion located on the angle. (B) Postendoscopic full-thickness gastric resection and closure with three over-the-scope clips.

  • Fig. 3 (A) Endoscopic findings of a subepithelial tumor on the cardia. (B) The proper muscle layer is visibly exposed after tumorectomy. (C) Endoscopic ultrasonography findings of tumor raised from the proper muscle layer. (D) One over-the-scope clip was placed on the tumorectomy lesion to prevent perforation.


Cited by  1 articles

Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations
Nobuyoshi Takeshita, Khek Yu Ho
Clin Endosc. 2016;49(5):438-443.    doi: 10.5946/ce.2016.104.


Reference

1. Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc. 2007; 21:994–997. PMID: 17453289.
Article
2. Yoshikane H, Hidano H, Sakakibara A, et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc. 1997; 46:464–466. PMID: 9402126.
Article
3. Trecca A, Gaj F, Gagliardi G. Our experience with endoscopic repair of large colonoscopic perforations and review of the literature. Tech Coloproctol. 2008; 12:315–321. PMID: 19018468.
Article
4. Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010; 89:931–936. PMID: 20172156.
Article
5. Repici A, Arezzo A, De Caro G, et al. Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis. 2009; 41:406–410. PMID: 18930700.
Article
6. Kirschniak A, Kratt T, Stüker D, Braun A, Schurr MO, Königsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007; 66:162–167. PMID: 17591492.
Article
7. Arezzo A, Kratt T, Schurr MO, Morino M. Laparoscopic-assisted transgastric cholecystectomy and secure endoscopic closure of the transgastric defect in a survival porcine model. Endoscopy. 2009; 41:767–772. PMID: 19685422.
Article
8. Kratt T, Küper M, Traub F, et al. Feasibility study for secure closure of natural orifice transluminal endoscopic surgery gastrotomies by using over-the-scope clips. Gastrointest Endosc. 2008; 68:993–996. PMID: 18984107.
Article
9. Voermans RP, van Berge Henegouwen MI, Bemelman WA, Fockens P. Novel over-the-scope-clip system for gastrotomy closure in natural orifice transluminal endoscopic surgery (NOTES): an ex vivo comparison study. Endoscopy. 2009; 41:1052–1055. PMID: 19899030.
Article
10. Von Renteln D, Vassiliou MC, Rothstein RI. Randomized controlled trial comparing endoscopic clips and over-the-scope clips for closure of natural orifice transluminal endoscopic surgery gastrotomies. Endoscopy. 2009; 41:1056–1061. PMID: 19899033.
Article
11. Cho WY, Kim YJ, Cho JY, et al. Hybrid natural orifice transluminal endoscopic surgery. Endoscopic full-thickness resection of early gastric cancer and laparoscopic regional lymph node dissection: 14 human cases. Endoscopy. 2011; 43:134–139. PMID: 21108175.
12. Chu YY, Lien JM, Tsai MH, et al. Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer. BMC Gastroenterol. 2012; 12:124. PMID: 22978826.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr